Browsing by Author "Benza, Raymond L"
Now showing 1 - 8 of 8
Results Per Page
Sort Options
Item Open Access Challenges in Pulmonary Hypertension: Controversies in Treating the Tip of the Iceberg. A Joint National Institutes of Health Clinical Center and Pulmonary Hypertension Association Symposium Report(American Journal of Respiratory and Critical Care Medicine, 2018-07-15) Elinoff, Jason M; Agarwal, Richa; Barnett, Christopher F; Benza, Raymond L; Cuttica, Michael J; Gharib, Ahmed M; Gray, Michael P; Hassoun, Paul M; Hemnes, Anna R; Humbert, Marc; Kolb, Todd M; Lahm, Tim; Leopold, Jane A; Mathai, Stephen C; McLaughlin, Vallerie V; Preston, Ioana R; Rosenzweig, Erika B; Shlobin, Oksana A; Steen, Virginia D; Zamanian, Roham T; Solomon, Michael AItem Open Access Hemodynamic Response to Treatment of Iron Deficiency Anemia in Pulmonary Arterial Hypertension: Longitudinal Insights from an Implantable Hemodynamic Monitor(Pulmonary Circulation, 2016-12) Mehmood, Muddassir; Agarwal, Richa; Raina, Amresh; Correa‐Jaque, Priscilla; Benza, Raymond LDespite new therapeutic options, pulmonary arterial hypertension (PAH) remains a progressive disease associated with substantial morbidity and mortality. As such, additional strategies for monitoring and adjunctive management of this disease are important. A 59-year-old woman with scleroderma-associated PAH received an implantable hemodynamic monitor (IHM) as part of a research protocol at our institution. Pulmonary artery pressures, heart rate, and cardiac output (sensor-based algorithm) were measured on a daily basis, and parameters of right ventricular (RV) performance and afterload were calculated. At the time of IHM implant, the patient had functional class III symptoms, was receiving triple-drug therapy, and had normal hemoglobin levels. Four months after implant, and with further optimization of prostacyclin therapy, she had improvement in her symptoms. However, shortly thereafter, while the patient was receiving stable drug therapy, her case regressed with worsening symptoms, and the patient received a new diagnosis of iron deficiency anemia. Oral iron supplementation resulted in normalization of hemoglobin levels and improvement in the patient's iron profile. A gradual and sustained reduction in pulmonary pressures was noted after initiation of oral iron accompanied by increased RV performance and favorable reduction in RV afterload. The patient had significant symptomatic improvement. Iron deficiency is an underappreciated yet easily treatable risk factor in PAH. Use of IHM in this case longitudinally illustrates the optimization of pulmonary hemodynamics and RV afterload in tandem with clinical improvement achieved by a simple therapy.Item Unknown Is Anticoagulation Beneficial in Pulmonary Arterial Hypertension?(Circulation. Cardiovascular quality and outcomes, 2018-09) Khan, Muhammad Shahzeb; Usman, Muhammad Shariq; Siddiqi, Tariq Jamal; Khan, Safi U; Murad, M Hassan; Mookadam, Farouk; Figueredo, Vincent M; Krasuski, Richard A; Benza, Raymond L; Rich, Jonathan DBackground Data about anticoagulation in pulmonary arterial hypertension (PAH) patients are inconsistent. The objective of this study was to examine the impact of adjunctive oral anticoagulants in patients with PAH through meta-analysis, and to further assess whether response differs by PAH subtype. Methods and Results Cochrane CENTRAL, Medline, and Scopus databases were searched for randomized or nonrandomized studies that assessed the association between anticoagulation and outcomes in patients with PAH. Hazard ratios (HRs) for mortality were pooled using the random effects model. Subgroup analyses were performed for type of PAH and study design. Twelve nonrandomized studies, at moderate risk of bias, were included. These consisted of 2512 patients (1342 receiving anticoagulation and 1170 controls). Anticoagulation significantly reduced mortality in the overall PAH cohort (HR, 0.73 [0.57, 0.93]; P=0.001; I2=64%). On subgroup analysis, a significant mortality reduction was seen in idiopathic PAH patients (HR, 0.73 [0.56, 0.95]; P=0.02; I2=46%), whereas no significant difference was observed in connective tissue disease-related PAH (HR, 1.16 [0.58, 2.32]; P=0.67; I2=71%). Sensitivity analysis specific to scleroderma-associated PAH demonstrated a significant increase in mortality with anticoagulant use (HR, 1.58 [1.08, 2.31]; P=0.02; I2=9%). Conclusions This meta-analysis shows that use of anticoagulation may improve survival in idiopathic PAH patients, while increasing mortality when used in scleroderma-associated-PAH patients. Currently, no randomized clinical trials have been published, and until randomized data are available, anticoagulant use in PAH should be tailored to PAH subtype.Item Unknown Macitentan (Opsumit) for the treatment of pulmonary arterial hypertension(Expert Review of Clinical Pharmacology, 2014-07) Clarke, Megan; Walter, Claire; Agarwal, Richa; Kanwar, Manreet; Benza, Raymond LItem Open Access Management of Pulmonary Hypertension due to Heart Failure with Preserved Ejection Fraction(Current Hypertension Reports, 2014-12) Kanwar, Manreet; Tedford, Ryan J; Agarwal, Richa; Clarke, Megan M; Walter, Claire; Sokos, George; Murali, Srinivas; Benza, Raymond LItem Open Access Monitoring Pulmonary Arterial Hypertension Using an Implantable Hemodynamic Sensor.(Chest, 2019-06-29) Benza, Raymond L; Doyle, Mark; Lasorda, David; Parikh, Kishan S; Correa-Jaque, Priscilla; Badie, Nima; Ginn, Greg; Airhart, Sophia; Franco, Veronica; Kanwar, Manreet K; Murali, Srinivas; Raina, Amresh; Agarwal, Rahul; Rajagopal, Sudarshan; White, Jason; Biederman, RobertBACKGROUND:Pulmonary arterial hypertension (PAH) is a chronic disease that ultimately progresses to right-sided heart failure (HF) and death. Close monitoring of pulmonary artery pressure (PAP) and right ventricular (RV) function allows clinicians to appropriately guide therapy. However, the burden of commonly used methods to assess RV hemodynamics, such as right heart catheterization, precludes frequent monitoring. The CardioMEMS HF System (Abbott) is an ambulatory implantable hemodynamic monitor, previously only used in patients with New York Heart Association (NYHA) class III HF. In this study, we evaluate the feasibility and early safety of monitoring patients with PAH and right-sided HF using the CardioMEMS HF System. METHODS:The CardioMEMS HF sensors were implanted in 26 patients with PAH with NYHA class III or IV right-sided HF (51.3 ± 18.3 years of age, 92% women, 81% NYHA class III). PAH therapy was tracked using a minimum of weekly reviews of CardioMEMS HF daily hemodynamic measurements. Safety, functional response, and hemodynamic response were tracked up to 4 years with in-clinic follow-ups. RESULTS:The CardioMEMS HF System was safely used to monitor PAH therapy, with no device-related serious adverse events observed and a single preimplant serious adverse event. Significant PAP reduction and cardiac output elevation were observed as early as 1 month postimplant using trends of CardioMEMS HF data, coupled with significant NYHA class and quality of life improvements within 1 year. CONCLUSIONS:The CardioMEMS HF System provided useful information to monitor PAH therapy, and demonstrated short- and long-term safety. Larger clinical trials are needed before its widespread use to guide therapy in patients with severe PAH with right-sided HF.Item Open Access Role of Phosphodiesterase-5 Inhibitors in Heart Failure: Emerging Data and Concepts(Current Heart Failure Reports, 2013-03) Kanwar, Manreet; Agarwal, Richa; Barnes, Megan; Coons, James; Raina, Amresh; Sokos, George; Murali, Srinivas; Benza, Raymond LItem Open Access Significance of Residual Mitral Regurgitation After Continuous Flow Left Ventricular Assist Device Implantation(JACC: Heart Failure, 2017-02) Kassis, Hayah; Cherukuri, Krishna; Agarwal, Richa; Kanwar, Manreet; Elapavaluru, Subbarao; Sokos, George G; Moraca, Robert J; Bailey, Stephen H; Murali, Srinivas; Benza, Raymond L; Raina, Amresh